phlems1 sudden infant death syndrome (sids) presented by jackie yates-feller, nremt-p, pi
TRANSCRIPT
PHLEMSPHLEMS 11
SUDDEN INFANT SUDDEN INFANT DEATH SYNDROME DEATH SYNDROME (SIDS)(SIDS)
Presented byPresented by
Jackie Yates-Feller, NREMT-P, PIJackie Yates-Feller, NREMT-P, PI
PHLEMSPHLEMS 22
ObjectivesObjectivesUpon completion of this presentation, Upon completion of this presentation,
the student will be able to:the student will be able to: – Define SIDSDefine SIDS– Describe the general population Describe the general population
characteristics of a probable SIDS characteristics of a probable SIDS infantinfant
– Describe the common physical Describe the common physical characteristics of a probablecharacteristics of a probable SIDS SIDS infantinfant
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ObjectivesObjectives Describe the typical scenario of a Describe the typical scenario of a
probable SIDS probable SIDS Identify important actions which Identify important actions which
should be initiated by an emergency should be initiated by an emergency responderresponder
Identify potential responses of Identify potential responses of parents to an infant deathparents to an infant death
Identify potential responses of Identify potential responses of emergency responders to an infant emergency responders to an infant deathdeath
PHLEMSPHLEMS 44
ObjectivesObjectives Identify common signs & Identify common signs &
symptoms of Critical Incident symptoms of Critical Incident Stress (CIS)Stress (CIS)
Identify strategies for Identify strategies for decreasing the impact of decreasing the impact of Critical Incident Stress (CIS)Critical Incident Stress (CIS)
Identify community resources Identify community resources available to parentsavailable to parents
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Definition - SIDSDefinition - SIDS
the sudden death of an infant, usually under 1 year of age, which remains unexplained after a complete postmortem investigation, including an autopsy, examination of the death scene and review of the case history
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SIDS StatisticsSIDS Statistics
Classified as a disorderClassified as a disorder Leading cause of death in Leading cause of death in
infants 1 month to 1 year oldinfants 1 month to 1 year old 95% occur between 1 & 6 95% occur between 1 & 6
months of age - peak period months of age - peak period between 2 & 4 monthsbetween 2 & 4 months
3,000 SIDS deaths per year in 3,000 SIDS deaths per year in the U.S.the U.S.
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SIDS - What It IsSIDS - What It Is
Major cause of death in infants Major cause of death in infants after 1st month of lifeafter 1st month of life
Sudden & silent in an apparently Sudden & silent in an apparently healthy infanthealthy infant
Unpredictable & unpreventableUnpredictable & unpreventable Quick death with no signs of Quick death with no signs of
suffering - usually during sleepsuffering - usually during sleep
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SIDS - What It Is NotSIDS - What It Is Not
Caused by vomiting or chokingCaused by vomiting or choking Caused by external suffocation or Caused by external suffocation or
overlayingoverlaying Contagious or HereditaryContagious or Hereditary Child abuseChild abuse Caused by lack of loveCaused by lack of love Caused by immunizationsCaused by immunizations Caused by allergy to cows milkCaused by allergy to cows milk
PHLEMSPHLEMS 99
General Characteristics of General Characteristics of SIDSSIDS Usually occurs in colder monthsUsually occurs in colder months Mothers younger than 20 years oldMothers younger than 20 years old Babies of smoking mothers or mothers Babies of smoking mothers or mothers
exposed to second hand smokeexposed to second hand smoke 60% male Vs 40% female60% male Vs 40% female Premature or low birth weightPremature or low birth weight Upper respiratory infections, 60% in Upper respiratory infections, 60% in
prior weeksprior weeks Occurs quickly and quietly during a Occurs quickly and quietly during a
period of presumed sleepperiod of presumed sleep
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SIDS ResearchSIDS Research
Evidence shows victims not Evidence shows victims not as normal as they seemas normal as they seem
Maybe subtle but, Maybe subtle but, undetectable, defects undetectable, defects present at birthpresent at birth
Areas presently under Areas presently under researchresearch– Brain abnormalitiesBrain abnormalities– Sleep positionSleep position– Multiple, non-life Multiple, non-life
threatening abnormalitiesthreatening abnormalities
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Medical Findings Medical Findings Consistent With SIDSConsistent With SIDS
Differences seen in Differences seen in external external appearance appearance versus internal versus internal appearance seen appearance seen on autopsy.on autopsy.
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External AppearanceExternal Appearance
Normal state of hydration & nutritionNormal state of hydration & nutrition Small amount of frothy fluid in or about mouth & noseSmall amount of frothy fluid in or about mouth & nose Vomitus presentVomitus present Postmortem lividity &/or rigorsPostmortem lividity &/or rigors Livormortis Livormortis Disfiguration/Unusual position - dependant blood Disfiguration/Unusual position - dependant blood
pooling/pressure markspooling/pressure marks
PHLEMSPHLEMS 1313
Internal Appearances On Internal Appearances On AutopsyAutopsy
Pulmonary congestion Pulmonary congestion & edema& edema
Intrathoracic petechiae Intrathoracic petechiae 90% of time90% of time
Stomach contents in Stomach contents in tracheatrachea
Microscopic Microscopic inflammation in inflammation in tracheatrachea
PHLEMSPHLEMS 1414
Typical SIDS Infant Typical SIDS Infant ScenarioScenario
Almost always occurs during sleep or Almost always occurs during sleep or appearance of sleepappearance of sleep
Usually healthy prior to deathUsually healthy prior to death May have had a cold or recent May have had a cold or recent
physical stressphysical stress May have been place down for nap, May have been place down for nap,
found not breathing or appearing found not breathing or appearing deaddead
Parents not hearing signs of struggleParents not hearing signs of struggle
PHLEMSPHLEMS 1515
Emergency Responder Emergency Responder ActivityActivity
Initiate Initiate resuscitation resuscitation per per department department procedures procedures and guidelinesand guidelines
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Emergency Responder Emergency Responder Activity Cont.Activity Cont. Support of ParentsSupport of Parents
– Use calm directive voiceUse calm directive voice– Be clear in instructionsBe clear in instructions– Provide explanations about Tx & Provide explanations about Tx &
transporttransport– Reassure that there was nothing that Reassure that there was nothing that
they could have donethey could have done– Do not be afraid of tears & angerDo not be afraid of tears & anger– Allow parents to accompany infant to Allow parents to accompany infant to
hospital if situation permitshospital if situation permits
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Emergency Responder Emergency Responder Activity Cont.Activity Cont. Obtain HxObtain Hx
– Illicit medical Illicit medical historyhistory
– Listen to the Listen to the parentsparents
– Do not ask Do not ask judgmental or judgmental or leading questionsleading questions
Use open-ended & Use open-ended & non-leading questionsnon-leading questions– Had infant been Had infant been
sicksick
– What happened What happened – Who found the Who found the
infant & whereinfant & where– What did (s)he doWhat did (s)he do– Had the infant Had the infant
been movedbeen moved– What time was What time was
infant last seen & infant last seen & by whomby whom
– How was infant How was infant that daythat day
– Last feedingLast feeding
PHLEMSPHLEMS 1818
Environmental Environmental AssessmentAssessment
Observe forObserve for– Location of infantLocation of infant– Presence of objects in Presence of objects in
area infant foundarea infant found– Unusual conditionsUnusual conditions
High room temperatureHigh room temperature OdorsOdors Anything out of Anything out of
ordinaryordinary
PHLEMSPHLEMS 1919
Anticipated Parental Anticipated Parental ResponsesResponses Normal responses may include:Normal responses may include:
– Denial, shock and disbeliefDenial, shock and disbelief– Anger, rage and hostilityAnger, rage and hostility– Hysteria or withdrawalHysteria or withdrawal– Intense guiltIntense guilt– Fear, helplessness and confusionFear, helplessness and confusion– No visible responseNo visible response– May or may not accept infants May or may not accept infants
deathdeath
PHLEMSPHLEMS 2020
Expected Requests From Expected Requests From ParentsParents
Repetitive questionsRepetitive questions Request to not initiate careRequest to not initiate care Request to be alone with Request to be alone with
infantinfant Request to terminate Request to terminate
resuscitation effortsresuscitation efforts Requests for cause of deathRequests for cause of death
PHLEMSPHLEMS 2121
If Parents Interfere With If Parents Interfere With CareCare Show empathyShow empathy Do not become angered or Do not become angered or
argumentativeargumentative Avoid restraining parentAvoid restraining parent Be professional - put Be professional - put
yourself in their shoesyourself in their shoes
PHLEMSPHLEMS 2222
Emergency Personnel Emergency Personnel ResponsesResponses Withdrawal, Withdrawal,
avoidance of avoidance of parentsparents
Self-doubtSelf-doubt Anger - wanting to Anger - wanting to
blame someoneblame someone Identification with Identification with
parentsparents Sadness & Sadness &
depressiondepression
PHLEMSPHLEMS 2323
Emergency Responder Emergency Responder Expectations of Parent’s Expectations of Parent’s BehaviorBehavior Hysterical & tearful responsesHysterical & tearful responses Disbelief that not every Disbelief that not every
parents will initiate CPRparents will initiate CPR Disbelief/unable to accept Disbelief/unable to accept
parents decision to not have parents decision to not have CPR startedCPR started
Cultural differences in Cultural differences in mourning and grieving processmourning and grieving process
PHLEMSPHLEMS 2424
Critical Incident Stress Critical Incident Stress (CIS) Management(CIS) Management
Stress is an Stress is an integral part integral part
of the of the profession profession
of of Emergency Emergency
ServicesServices
PHLEMSPHLEMS 2525
Signs & Symptoms of Signs & Symptoms of CISCIS Anger/irritabilityAnger/irritability Physical illnessPhysical illness DepressionDepression Recurring Recurring
dreamsdreams Intrusive imagesIntrusive images Changes in sleep Changes in sleep
patternspatterns Mood Mood
changes/swingschanges/swings
WithdrawalWithdrawal Changes in eating Changes in eating
habitshabits Inability to Inability to
concentrateconcentrate Restlessness/Restlessness/
agitationagitation Loss of emotional Loss of emotional
controlcontrol Increased alcohol Increased alcohol
consumptionconsumption
PHLEMSPHLEMS 2626
Strategies for Decreasing Strategies for Decreasing Impact of CISImpact of CIS Talk to your peers/ share your feelingsTalk to your peers/ share your feelings Exercise and balanced dietExercise and balanced diet Avoid OT & plan leisure timeAvoid OT & plan leisure time Write a personal journalWrite a personal journal Obtain personal or religious Obtain personal or religious
counselingcounseling Request dispatch tape reviewsRequest dispatch tape reviews Request assistance from you local Request assistance from you local
CISM team, post incidentCISM team, post incident
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SIDS ResourcesSIDS ResourcesNational SIDS Resource Center
(703) 821-8955SIDS Alliance (800) 221-SIDS
WWW.sidsalliance.orgNational Institute of Child Health &
DevelopmentWWW.nih.gov/nichd/
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ReferencesReferences California Fire Chiefs Association, Emergency Medical Section, California Fire Chiefs Association, Emergency Medical Section,
“Sudden Infant Death Syndrome Instructor Instructor Guide”April “Sudden Infant Death Syndrome Instructor Instructor Guide”April 1991.1991.
Department of Health, Education & Welfare, Public Health Service Department of Health, Education & Welfare, Public Health Service Administration, Bureau of Community Health Services “Training Administration, Bureau of Community Health Services “Training Emergency Responders: SIDS An Instructor Manual, DEW Emergency Responders: SIDS An Instructor Manual, DEW Publications No (HAS) 79-5253, 1979Publications No (HAS) 79-5253, 1979
State of California EMS Authority, “SIDS Training Packet For State of California EMS Authority, “SIDS Training Packet For Emergency Medical Responders and Firefighters”, September 1990Emergency Medical Responders and Firefighters”, September 1990
American SIDS Institute, “SIDS: Toward an UnderstandingAmerican SIDS Institute, “SIDS: Toward an Understanding Colorado SIDS Program, “Commonly Asked Questions About SIDS: A Colorado SIDS Program, “Commonly Asked Questions About SIDS: A
Doctor’s Response” J Bruce Beckwith M.D. 19983Doctor’s Response” J Bruce Beckwith M.D. 19983 National SIDS Resource Center, “Information Sheet: What is SIDS, National SIDS Resource Center, “Information Sheet: What is SIDS,
May 1993May 1993 Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2Center for Pediatric Emergency Medicine, “TRIPP” 1998, Version 2
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References Cont.References Cont. National SIDS Clearing House, “Fact Sheet: SIDS Information The National SIDS Clearing House, “Fact Sheet: SIDS Information The
EMT”EMT” David Lawrence, “SIDS Handle With Care” JEMS, December 1988David Lawrence, “SIDS Handle With Care” JEMS, December 1988 Seasonality in SIDS-U.S. 1980-1987”, MMWR, December 14, 1990, Seasonality in SIDS-U.S. 1980-1987”, MMWR, December 14, 1990,
Vol..39., No. 49Vol..39., No. 49 From the CDC, Atlanta, Georgia, “Seasonality in SIDS” JAMA, From the CDC, Atlanta, Georgia, “Seasonality in SIDS” JAMA,
February,13, 1991, Vol. . 265, o. 6.February,13, 1991, Vol. . 265, o. 6. From The National Health Institute< ‘Chronic Fetal Hypoxia From The National Health Institute< ‘Chronic Fetal Hypoxia
Predispose Infants to SIDS, JAMA, December 5, 1990, Vol.. 264, No. Predispose Infants to SIDS, JAMA, December 5, 1990, Vol.. 264, No. 21.21.
Carroll, John L. & Loughlin, Gerald M., “Sudden Infant Death Carroll, John L. & Loughlin, Gerald M., “Sudden Infant Death Syndrome” Pediatric review, Vol.. 14, No. 3., March 1993Syndrome” Pediatric review, Vol.. 14, No. 3., March 1993
Jackson, & Community Midwifery, United Leeds Teaching Hospital Jackson, & Community Midwifery, United Leeds Teaching Hospital Trust SIDS PART 1” Definitions & Classification of SIDS”, Midwifery Trust SIDS PART 1” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992Chronicles & Nursing Notes, August 1992
PHLEMSPHLEMS 3030
References Cont.References Cont. Jackson, & Community Midwifery, United Leeds Teaching Jackson, & Community Midwifery, United Leeds Teaching
Hospital Trust SIDS PART 2” Definitions & Classification of Hospital Trust SIDS PART 2” Definitions & Classification of SIDS”, Midwifery Chronicles & Nursing Notes, August 1992SIDS”, Midwifery Chronicles & Nursing Notes, August 1992
Florida Emergency Medicine Foundation & California EMS Florida Emergency Medicine Foundation & California EMS Authority, “Pediatric Education for Paramedics” 1997Authority, “Pediatric Education for Paramedics” 1997
American SIDS Institute, “Coping With Infant Loss, Grief American SIDS Institute, “Coping With Infant Loss, Grief and Bereavement”, June 1994and Bereavement”, June 1994
American SIDS Institute, “Helping A Friend Cope With American SIDS Institute, “Helping A Friend Cope With Infant Loss, Grief and Bereavement, June 1994Infant Loss, Grief and Bereavement, June 1994
Parrott, Carol, “Parent’s Grief Help & Understanding After Parrott, Carol, “Parent’s Grief Help & Understanding After The Death of a Baby”, Medic Publishing Company, 1992The Death of a Baby”, Medic Publishing Company, 1992
Klobadans, David, “First Responders and EMS Personnel - Klobadans, David, “First Responders and EMS Personnel - SIDS Training Outline” SIDS Training Outline”